Hip spica cast and undergarment for use with hip spica cast

ABSTRACT

An undergarment for use with a cast tape to form a hip spica cast, such as a pantaloon-type hip spica cast, The cast includes at least one layer of a 3D spacer synthetic padding material formed into a fabric of monofilament yams and fabricated into an anatomically correct undergarment structure for being positioned around a torso and residing directly against the skin of a hip spica cast patient. At least one fabric perineal panel is attached to the undergarment in the perineal area of the undergarment and adapted for being positioned on an overlying cast material defining a perineal opening in the cast.

TECHNICAL FIELD AND BACKGROUND OF THE INVENTION

This invention relates to an undergarment formed of orthopedic padding,for example, for use as an undercast padding of the type used to protectand cushion the skin of a patient from the relatively rigid material ofa cast, such as those constructed of plaster of Paris or synthetic casttape. Specifically, this invention relates to a hip spica cast intendedprimarily for infants and other pediatric patients. The cast isconstructed of an undercast padding material characterized by having avery open water and air transmissive structure enclosed within a veryopen water and air transmissive cast tape.

A cast which includes the torso of the body and one or more limbs iscalled a spica cast. A hip spica includes the torso of the body and oneor more legs. A hip spica which covers only one leg to the ankle or footmay be referred to as a single hip spica, while one which covers bothlegs is called a double hip spica. A one-and-a-half hip spica encasesone leg to the ankle or foot and the other to just above the knee. Theextent to which the hip spica covers the torso depends greatly on theinjury and the surgeon; the spica may extend only to the navel, allowingmobility of the spine and the possibility of walking with the aid ofcrutches, or may extend to the rib cage or even to the armpits in somerare cases. Hip spicas are used for a number of conditions and injuries,such as congenital hip dislocation or dysplasia.

In some cases, a hip spica may only extend down one or both legs toabove the knee. Such casts, called pantaloon casts, are used toimmobilize an injured lumbar spine or pelvis, in which case the torsoportion of the cast usually extends upwardly to or just below thearmpits. The specific example discussed in this application is such apantaloon cast, but the invention is not limited to this particular typeof cast.

A traditional hip spica cast is constructed from a simple stockinetteand padding material made from cotton or synthetic fibers, and offerspoor or no water resistant capability. Cotton and some synthetic paddingactually absorb and retain large quantities of water. A hip spica castis typically worn for a period of 6-10 weeks. During this period oftime, traditional casts having a water-absorbent stockinette can promoteskin maceration and discomfort. This is a particular problem withinfants and very small children who are incontinent and therefore arefar more likely to soil the cast with urine and feces. To facilitatetoileting or diaper changing and hygienic cleaning, an opening, referredto as the “perineal opening”, is typically created in the cast at thegroin. It is formed either during cast application or after castapplication by cutting the hole with a cast saw. The opening must thenbe petalled or lined to keep this area of the cast clean and dry.However, this is difficult, particularly with infants and smallchildren. In reality, within a relatively short period of time aftertraditional hip spica cast application, the area around the perinealopening becomes soiled with urine and feces and develops foul odors thatmust be tolerated or masked with various deodorizers for a month ormore. Rashes, maceration, skin and systemic infections, open sores andother conditions may retard the treatment schedule and impose pain anddiscomfort on the infant or pediatric patient.

The present invention provides a more conformable, water-resistantproduct that permits the material to be formed into ananatomically-shaped and sized undergarment that can be donned onto thepatient, and then enclosed by wrapping with a suitable water and airpermeable synthetic cast tape to form the spica cast. The perineal areaof the garment includes protective panels of fabric that areincorporated into the garment and which can be pulled out of the garmentand folded around the hardened part of the outer cast to preventrubbing, particularly when a diaper is pushed through the perinealopening from the outside.

One of the problems with conventional cast padding as well ascommercially available water resistant padding is that the paddingcollapses underneath a cast over the duration of 4-6 weeks as water andperspiration are absorbed into the structure. This reduction inthickness and resultant increase in density retards moisture transfer byboth wicking and evaporation, and lessens the protection offered by thepadding.

The hip spica cast according to the present invention accommodatesbathing, showering and contact with water for cleansing while permittingsurface moisture to be dried, and moisture on the interior of the hipspica cast to evaporate relatively quickly, leaving the patient dry andcomfortable. For smaller patients, the patient can be held in proximityto, for example, a handheld spray nozzle and the cast sprayed with agentle spray of warm, cleansing water. Urine is readily washed away, andfeces are dissolved, diluted and allowed to drain away. The patient isleft clean and odor-free. Excess surface water is easily blotted awaywith an absorbent cloth or paper towel, and water on the interiorevaporates within about one hour. This process can be repeated asnecessary during the entire treatment period. Moreover, because of theability to cleanse the patient as described above, it may not benecessary to provide the perineal opening in some instances.

SUMMARY OF THE INVENTION

Therefore, it is an object of the invention to provide a hip spica castformed from a water and air permeable padding material formed into agarment, and enclosed within a water and air permeable synthetic casttape. It is another object of the invention to provide an orthopedicpadding that is comfortable when worn under a synthetic cast.

It is another object of the invention to provide a hip spica cast in theform of a garment that is relatively thin but still providing sufficientcushioning and thus provides a low profile undercast layer when properlyoverlapped during application.

It is another object of the invention to provide a hip spica east thatis relatively open and therefore breathable.

It is another object of the invention to provide a hip spica cast thatis resistant to collapse during extended use.

It is another object of the invention to provide a hip spica cast thatpromotes drainage of water from the cast when wetting occurs.

It is another object of the invention to provide a breathable hip spicacast that is comfortable when worn against the skin under a wrapping ofsynthetic cast tape.

It is another object of the invention to provide a breathable hip spicacast that includes perineal panels that protect the wearer from contactwith the hard outer cast material, and prevent rubbing and chafing whena diaper is being inserted into the cast through the perineal opening.

These and other objects of the present invention are achieved byproviding an undergarment for use with a cast tape to form a hip spicacast, and comprising

BRIEF DESCRIPTION OF THE DRAWINGS

Some of the objects of the invention have been set forth above. Otherobjects and advantages of the invention will appear as the inventionproceeds when taken in conjunction with the following drawings, inwhich:

FIG. 1 is a perspective view of a hip spica cast undergarment accordingto one embodiment of the invention;

FIG. 2 is a perspective view of the hip spica cast undergarmentaccording to FIG. 1 with parts broken away to reveal protective perinealpanels;

FIG. 3 is an environmental view showing a hip spica east undergarment inplace on an infant;

FIG. 4 is a view similar to FIG. 3 showing the front and rear perinealpanels pulled to the outside of the undergarment;

FIG. 5 is a view similar to FIG. 4 showing the front and rear perinealpanels pulled to the outside of the undergarment; and

FIG. 6 is a view showing the hip spica cast after cast tape has beenapplied over the undergarment with the perineal panels pulled to theoutside to cover the cast edges in the perineal area.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENT OF THE INVENTION AND BESTMODE

Referring now specifically to the drawings, a hip spica undergarment 10is shown. The particular hip spica undergarment 10 is a pantaloon hipspica that extends from below the armpits of the patient to above theknees, particularly intended for infants and small children. As notedabove, there are other types of hip spica casts, and those are includedwithin the scope of the invention even though not further described. Theundergarment 10 includes a torso 12 and two integrally-formed legs 14and 16 that are constructed of front and back blanks 18 and 20 ofpadding material that are connected to form the undergarment 10 asshown. The seams of the undergarment 10 may be formed by any suitablemethod, such as ultrasonic welding, butt or overedge seaming, or with anadhesive, either in tape or atomized glue form.

Each leg 14 and 16 is formed of double layers of fabric that form frontand back blanks 18A, 18B, 20A, 20B, respectively. The undergarment 10also includes a pair of fabric outer side gussets 22 and 24 insertedbetween the pairs of layers 18A, 18B and 20A, 20B respectively, asshown, that extend along the distal aspects of the undergarment 10 fromthe waist opening 26 to the leg openings 28, 30. Similarly, an innergusset 36 is inserted between the pairs of fabric layers 18A, 18B and20A, 20B respectively, as shown, and extends in a curved proximalconfiguration up each leg 14, 16 and across the perineal area.

Preferably, the undergarment 10 is provided with locator markings toindicate to the technician the location and size of a perineal opening.The markings may indicate a perineal area 32 outlined with a contrastingcolor, stitching or any other suitable indicator. Alternatively, aperineal opening may be preformed in the undergarment 10 whenconstructed.

As best shown by reference to FIGS. 1 and 2, fabric front and rearprotective panels 40 and 42 are attached to the inside of theundergarment 10 and extend laterally across the perineal area 32 andpartially down legs 14, 16. The front panel 40 is interconnected withthe gusset 36 and the front leg blanks 18A, 20A, and the rear panel 42is interconnected with the gusset 36 and the rear leg blanks 18B, 20B.Therefore, a space the width of the inner gusset 36 is left between thefront and rear panels 40 and 42 in the perineal area. Note that thepanels 40, 42 are generally curved with the greatest dimension in theperineal area 32, tapering as they extend down the legs 14, 16.

To apply the undergarment 10, the patient is positioned in theundergarment 10 through the waist opening 26 with its legs extendingthrough respective leg openings 28, 30.

The double layers of fabric forming the front and back blanks 18A, 18Band 20A, 20B provide enhanced comfort while still providing a moisturevapor transmission rate (MVTR) of over 1000 g/m²/24 hrs. Otherembodiments may include single thickness or three or more thicknesses ofthe undergarment material. The front and back blanks 18A, 18B and 20A,20B are preferably formed of 4-6 mm thick 3D Knitted material with apillar stitch 0.07 mm polyester with an inlay of 100 decitex 72 filamentpolypropylene. The multifilament polypropylene yarn of the inlay acts asa barrier to any leaching of resin on the infant's skin.

The gussets 22, 24 and 36 are fabricated of 100 percent polypropylenemonofilament having a diameter of 0.1 mm to 0.3 mm. The thickness of thefabric is 3-4 mm.

The layers of fabric shown in FIGS. 1 and 2 can be constructed using anysuitable hydrophobic/water resistant monofilament or multifilament yarnsuch as polypropylene, polyester, polyethylene and nylon to providesufficient cushioning and breathability.

Preferably, the structure of the undergarment 10 should provide somestretch in both the length-wise and width-wise directions, andfacilitate conforming the undergarment 10 around an anatomical shapeduring application.

The fabric of the undergarment 10 can be treated with one or morefinishes to provide additional water resistance, anti-bacterial and/oranti-odor characteristics, or aromatherapy to improve the functionalityor enhance the cast-wearing experience for the patient. Alternatively,the padding material can be fabricated from modified/treatedmonofilament yarns incorporating suitable fillers or finishes to improvethe performance,

Referring now to FIG. 3, and by way of example, the undergarment 10 ofFIG. 3 is applied to the infant by donning it over the legs and upacross the torso to the medically-appropriate position—generally at orjust below the armpits. As noted above, the stretch provided by theundergarment 10 permits a fast, accurate, closely-conforming applicationwithout wrinkles or creases. No stockinette or other material is usedunderneath the undergarment 10. It resides directly against the skin. Aperineal opening 44 is either preformed in the undergarment 10 or formedduring application.

Referring now to FIGS. 4 and 5, after the undergarment 10 is placed onthe infant the protective panels 40 and 42, which are originally on theinterior of the undergarment 10, are pulled through the perineal opening44 from the inside to the outside. The front panel 40 resides around thefront end of the perineal opening 44 and the rear panel 42 residesaround the rear end of the perineal opening 44.

As is shown in FIG. 6, after application of the undergarment 10, an overcast 60 is formed by wrappings of synthetic cast tape 62. The preferredcast tape is Delta-Cast® brand synthetic fiber cast tape or Delta-Lite®brand fiberglass cast tape manufactured and sold by BSN medical, Inc.and BSN medical, GmbH. These cast tapes are supplied in various widths,the particular width being a choice left to the physician or casttechnician. Two-inch or three-inch cast tape is the most often used. Thecast tape 62 is removed from its moisture impervious pouch, wetted, andexcess water removed by wringing the cast tape 62 while wrapped in anabsorbent towel. The cast tape 62 is then applied over the undergarment10 by wrapping the cast tape 62 circumferentially around the patient,taking care in the usual manner to properly overlap adjacent wraps,eliminate wrinkles and puckers and leaving a short width of exposedundergarment at a top opening 66, leg openings 68 and 70, and theperineal opening 72, which is aligned and communicates with the perinealopening 44 in the undergarment 10. The result is the cast 60 shown inFIG. 6.

Formation of the perineal opening 72 in the cast leaves a rough, hardedge. The front and rear panels 40, 42 are then pulled from inside thecast 60 through the perineal opening 72 and arranged to overlie theedges of the perineal opening 72, thereby providing a protectivecovering that will prevent chaffing, abrasion and irritation to thetender skin of the upper inner legs and adjacent genital area.

The specific manner of application of the cast tape is a matter ofmedical procedure. One such procedure, illustrated with a prior artapplication of an underwrapping of strips of padding material, iscontained in Application Manual-Hip Spica Cast, published by BSNmedical, Inc., ©BSN medical, Inc., 2011, at pages 10-16.

The cast tape 62 hardens in several minutes to form the rigid cast 60 asshown in FIG. 6 that is nevertheless very water and air permeable.Typically, the torso portion of the cast 60 can be covered in a softcloth or garment, or the patient's arms covered in a soft garment, inorder to prevent chafing of the patient's arms against the outer surfaceof the cast tape 62 on the torso portion of the cast 60.

For infant or small juvenile patients, the patient can be held inproximity to, for example, a handheld spray nozzle and the cast sprayedwith a gentle spray of warm, cleansing water. Urine is readily washedaway, and feces are dissolved, diluted and allowed to drain away. Thepatient is left clean and odor-free. Excess surface water is easilyblotted away with an absorbent cloth or paper towel, and water on theinterior evaporates within about one hour. This process can be repeatedas necessary during the entire treatment period. Moreover, because ofthe ability to cleanse the patient as described above, it may not benecessary to provide the perineal opening in some instances.

An undergarment for use in forming a hip spica cast, and a hip spicacast according to the invention have been described with reference tospecific embodiments and examples. Various details of the invention maybe changed without departing from the scope of the invention.Furthermore, the foregoing description of the preferred embodiments ofthe invention and best mode for practicing the invention are providedfor the purpose of illustration only and not for the purpose oflimitation, the invention being defined by the claims.

We claim:
 1. A water and air permeable undergarment for use with a casttape to form water and air permeable hip spica cast, and comprising: (a)a layer of a fabric formed of synthetic yams and fabricated into ananatomically correct undergarment structure having a torso portion andfirst and second leg portions for being positioned onto a torso andlegs, and adapted to reside against the skin of, a wearer; (b) aperineal area positioned between the first and second legs; (c) a fabricperineal panel attached to the undergarment in the perineal area of theundergarment and adapted for being positioned on an overlying castmaterial defining a perineal opening in the cast, wherein: theundergarment is formed of water and air permeable padding layersdefining anterior and posterior sides of the undergarment, and (d) thetorso portion of the undergarment including a top opening for beingpositioned on the torso of the patient and at first and second legportions terminating in respective leg openings adapted to residebetween hips and knees of the patient the undergarment being formed offirst and second overlaid padding layers defining an anterior side ofthe undergarment and third and fourth overlaid padding layers definingan anterior side of the undergarment and third and fourth overlaidpadding layers defining a posterior side of the undergarment.
 2. Thewater and air permeable undergarment according to claim 1, wherein theundergarment has at least one integrally-formed leg portion.
 3. Thewater and air permeable undergarment according to claim 1, wherein theundergarment has a torso portion including a top opening for beingpositioned on a torso portion of the patient and at least oneintegrally-formed leg portion terminating in a leg opening adapted toreside between a hip and knee of the patient.
 4. The water and airpermeable undergarment according to claim 1, wherein the undergarmenthas a torso portion including a top opening for being positioned on atorso portion of the patient and a first leg portion and second legportion that terminate in respective leg openings adapted to residebetween the hips and knees of the patient.
 5. The water and airpermeable undergarment according to claim 1, wherein the first andsecond padding layers and the third and fourth padding layers are joinedwith monofilament yarns along left and right seam lines extending from atop opening to first and second leg openings at a lowermost terminus ofthe undergarment.
 6. The water and air permeable undergarment accordingto claim 5, wherein the monofilament yarns are thermoplastic and theseam lines are formed by a seaming process selected from the groupconsisting of ultrasonic energy, butt seaming, overedge seaming, joiningwith an adhesive tape and joining in with an atomized glue.
 7. The waterand air permeable undergarment according to claim 1, wherein theundergarment includes a perineal opening.
 8. The water and air permeableundergarment according to claim 1, wherein the undergarment isconfigured to form an undergarment for a pantaloon hip spica cast.
 9. Anundergarment according to claim 1, wherein the cast tape is selectedfrom the group consisting of a synthetic fiber or fiberglass/nonfiberglass substrate coated or saturated with a moisture-curable resinand stored in a flexible condition in a moisture impervious packageuntil use, at which time removal of the cast tape from the moistureimpervious package and exposure to moisture causes the substrate toharden over a time period sufficiently long to allow application of thecast tape while still flexible over the undergarment.
 10. A water andair permeable hip spica cast, comprising: (a) a water and air permeableundergarment comprising a padding layer formed of a 3D spacer syntheticpadding material that is water and air permeable and formed into afabric of monofilament yarns and fabricated into an anatomically correctundergarment structure for being positioned around a torso and adaptedto reside directly against the skin of a hip spica cast patient; (b) acast tape is selected from the group consisting of a synthetic fiber orfiberglass/non fiberglass substrate coated or saturated with amoisture-curable resin and stored in a flexible condition in a moistureimpervious package until use, at which time removal of the cast tapefrom the moisture impervious package and exposure to moisture causes thesubstrate to harden over a time period sufficiently long to allowapplication of the cast tape while still flexible over the undergarment;and (c) the cast tape adapted to be positioned circumferentially overthe undergarment and around the torso of the patient.
 11. The water andair permeable hip spica cast according to claim 10, wherein theundergarment comprises a pantaloon garment having a torso portion andfirst and second leg portions.
 12. The water and air permeable hip spicacast according to claim 10, wherein the undergarment has a torso portionincluding a top opening for being positioned on a torso portion of thepatient and at first and second leg portions terminating in respectiveleg openings adapted to reside between a hip and knee of the patient,and wherein the undergarment is formed of first and second overlaidpadding layers defining an anterior side of the undergarment and thirdand fourth overlaid padding layers defining a posterior side of theundergarment.
 13. The water and air permeable hip spica cast accordingto claim 10, wherein the first and second padding layers and the thirdand fourth padding layers are joined along left and right seam linesextending from a top opening to first and second leg openings at alowermost terminus of the undergarment.
 14. The water and air permeablehip spica cast according to claim 10, wherein the padding materialweighs between 100-250 g/m.sup.2.
 15. The water and air permeable hipspica cast according to claim 10, wherein the monofilament yarns arethermoplastic and the seam lines are formed by a seaming processselected from the group consisting of ultrasonic energy, butt seaming,overedge seaming, joining with an adhesive tape and joining in with anatomized glue.
 16. The water and air permeable hip spica cast accordingto claim 10, wherein the undergarment includes a perineal opening.